Choice Components

2. Language [DEMAND ITEM]

The service has changed the language and
a) no longer refers to assessment, treatment or triage appointments but either describes it to the family as Choice and Partnership or another local name and
b) when considering clinical skills refers to a clinical competency not a particular discipline

Is your rating? No (RED) = 0 Partial (AMBER) = 1 Yes (GREEN) = 2
The words we use lead us into certain ideas. ‘Assessment’ and ‘treatment’ are things we do to people and may distract us from working collaboratively. Using ‘Choice’ and ‘Partnership’ or other locally chosen words can help re-position us with clients as ‘facilitators with expertise’ rather than ‘experts with power’.

This item is a DEMAND item as using the old language of ‘assessment’ especially is likely to transfer more families from Choice to Partnership. It tends to make the Choice appointment a passive, problem - orientated experience for the family. If we stay with their choices and access their strengths then it can be easier to notice solutions outside CAMHS. This will ensure the percentage transfer rate to Partnership is appropriate.

Stop here and review the team position. You may want to discuss the ideas in the article ‘Choice vs. a traditional assessment’ in Chapter 5: Choice appointments.

3. Handle Demand [DEMAND ITEM]

This means making sure that the referrals are appropriate using eligibility criteria such as referrer seeing child and any appropriate community intervention has happened first, families can chose an initial Choice appointment when their referral is accepted i.e. full-booking and there is also a key focus on not allowing a waiting list to develop by flexing initial Choice capacity.

Is your rating? No (RED) = 0 Partial (AMBER) = 1 Yes (GREEN) = 2

The first sub component (eligibility) has a strong impact on DEMAND - are you accepting referrals that are appropriate? There is a key difference between accepting any referral that CAMHS could help (in other words, virtually anyone with a child!) rather than those we should help.
Are other services appropriately involved? Is the problem better suited to them or us? Think about your screening process - is there a culture of what ‘should’ we do, rather than what we ‘could’? Is there wide variation between clinicians over what is accepted and not? If there is, how you can help reduce this variation? Team discussion? Does the manager need to be present? Take a vote? Have a small screening team? What are your ideas?

4. Choice framework [DEMAND ITEM]

Carrying out the tasks in the Choice appointment of curiosity, honest opinion leading to joint formulation, discussion of alternatives, reaching a Choice Point and engagement.

This will probably result in not all families and young people choosing to return for Partnership. Your transfer percentage from Choice to Partnership is a guide to this. Much more than 75% and you probably aren’t engaging their strengths enough or are inadvertently being too problem/pathology focused.

Is your rating? No (RED) = 0 Partial (AMBER) = 1 Yes (GREEN) = 2

This DEMAND item is closely linked to Key Component 2: Language. If Choice is not done well or robustly a number of families and young people will progress to Choice who really don’t need to (and probably didn’t really want to!). The percentage increase may be small say 80% vs. 70% but they can all add up.

Do you know if there is a wide variation in transfer percentage? What is the range of team views over when a family should be offered an intervention? Diverting families to other local resources needs a good knowledge of what is available – so how is your resource file? Is it available and up to date? Is this anyone’s job?

Do a team workshop on when to offer a CAMHS intervention in your next team away day.